Trust Board Meeting in Public: Wednesday 14 March 2018 TB CQUIN Indicator 1b: Healthy food for NHS staff, visitors and patients 2017/18

Size: px

Start display at page:

Download "Trust Board Meeting in Public: Wednesday 14 March 2018 TB CQUIN Indicator 1b: Healthy food for NHS staff, visitors and patients 2017/18"

Emily Shields
6 years ago
Views:

Trust Board Meeting in Public: Wednesday 14 March 2018 Title CQUIN Indicator 1b: Healthy food for NHS staff, visitors and patients 2017/18 Status For approval History CQUIN 2016/17 - Trust Board - 8

1 Trust Board Meeting in Public: Wednesday 14 March 2018 Title CQUIN Indicator 1b: Healthy food for NHS staff, visitors and patients 2017/18 Status For approval History CQUIN 2016/17 - Trust Board - 8 March Trust Management Executive - 22 February Board ead(s) Mr Paul Brennan, Director of Clinical Services Dr Tony Berendt Medical Director Key purpose Strategy Assurance Policy Performance CQUIN 1b Healthy Food Page 1 of 11

2 Executive Summary 1. The retailers on all four sites have engaged positively and implemented changes, to achieve compliance to all four outcomes of the CQUIN NHS staff health and wellbeing Indicator 1b Healthier food for NHS staff, visitors and patients. 2. A significant amount of work has been undertaken by all the retailers but they have been engaged and willingly supported the Trust to achieve the CQUIN. Positive recognition of this by including them on both the Trust intranet and Trust website would be well received and justified. 3. The CQUIN requirements for are more onerous. 4. Recommendation The Trust Board is asked to ratify the work undertaken and to give sanction to the positive recognition of the retailers achievements. CQUIN 1b Healthy Food

3 CQUIN 2017/18 Indicator 1b: Healthy food for NHS staff, visitors and patients 1. Purpose 1.1. The purpose of this paper is to brief the Trust Board of the progress made on all four sites, to achieve the CQUIN NHS staff health and wellbeing, Indicator 1b; Healthy food for NHS staff, visitors and patients 1.2. A requirement of this particular part of the CQUIN is that by the 31 March 2018 the changes and the planned changes must have been discussed at a public Trust Board. 2. Background 2.1. The CQUIN was first issued in March 2016 by NHS England with an aim to drive the NHS, as an employer, to improve the health and wellbeing of its staff. Indicator 1b Healthier food for NHS staff, visitors and patients ; aims to change the organisational behaviour and culture towards food and drink sold on NHS premises, with a focus on making healthier food and drink more widely available It is estimated that nearly 700,000 NHS staff are obese or overweight. In Oxfordshire, 1 in year olds are overweight or obese and this rises to 54% of adults over Whilst the factors leading to obesity are complex, it is known that the overconsumption of calories is a major cause A reduction in the consumption of foods high in fat, sugar and salt (HFSS) has the potential to significantly improve health and wellbeing and lead to a reduction in levels of obesity. There is also a clear link between staff health and wellbeing, retention and patient care. NHS staff spend a large portion of their time at work, which is an opportunity to impact positively on their overall health, wellbeing and happiness. Evidence from Public Health England in 2015 found the cost to the NHS of sickness absence was 2.4 billion The Trust demonstrates a strong commitment to improving the population s health by building capacity to promote healthy lifestyles and developing a health promoting environment for all patients, visitors and staff. We are aiming to create and sustain a healthy hospital environment by providing healthy food and promoting balanced, healthy diets The wider aims of this CQUIN are demonstrated in the OUH Public Health Strategy and the CQUIN has also proved to be a useful catalyst for implementation of the Trust s Nutrition and Hydration Strategy This work has continued throughout 2017 in support of the Trust s public health agenda. CQUIN is only one component of the wider aims to improve the food environment CQUIN funds will be paid on: Continuing to deliver the four outcomes achieved in the 2016/17 CQUIN: a. The banning of price promotions on sugary drinks and foods high in fat, sugar and salt (HFSS); 1 Public Health England, PHE Outcomes Framework Health Improvement CQUIN 1b Healthy Food

4 b. The banning of advertisement on NHS premises of sugary drinks and foods high in fat sugar and salt (HFSS); c. The banning of sugary drinks and foods high in fat, sugar and salt (HFSS) from checkouts; and d. Ensuring that healthy options are available at any point including for those staff working night shifts Introducing three new changes to food and drink provision in 2017/18: 70% of drinks lines stocked must be sugar free (less than 5 grams of sugar per 100ml). In addition to the usual definition of SSBs it also includes energy drinks, fruit juices (with added sugar content of over 5g) and milk based drinks (with sugar content of over 10grams per 100ml). 60% of confectionery and sweets do not exceed 250 kcal. At least 60% of pre-packed sandwiches and other savoury pre-packed meals (wraps, salads, pasta salads) available contain 400kcal (1680 kj) or less per serving and do not exceed 5.0g saturated fat per 100g. 3. Engagement and changes achieved Engagement 3.1. Since 2014, all the retail and service providers within the Trust have met regularly to work towards a healthier eating agenda. This forum, the Healthier Eating Working Group (HEWG) has been used as a conduit for the work streams resulting from the CQUIN. The overall response is extremely positive and there is a strong willingness to engage and continually strive to make the changes necessary for a healthier eating environment at the Trust Workshops for the HEWG provided an opportunity to offer advice and support to all retailers. A session was held to educate retailers about what defined food and drinks high in fat, sugar and salt (HFSS). These workshops encouraged retailers to outline the challenges they experienced in achieving the CQUIN and to share knowledge and ideas of overcoming these challenges. Retailers worked together to identify opportunities for further step-changes to encourage and promote healthier eating options. Implementation 3.3. Each retailer has been audited against CQUIN indicators and the Trust s Nutrition and Hydration Strategy objectives. Meetings with retailers involved documenting and recognising the significant changes made since March 2017 and agreeing further step-changes before re-auditing in February 2018 against the CQUIN indicators. A summary of the implementation of step-changes amongst retailers on Trust premises to achieve the CQUIN indicators is attached as Appendix 1. Achievements 3.4. The outcome a) banning of price promotions on sugary drinks and foods high in fat, sugar and salt (HFSS) has been maintained in all outlets The outcome b) the banning of advertisement on NHS premises of sugary drinks and foods high in fat sugar and salt (HFSS) has been maintained in all outlets. CQUIN 1b Healthy Food

5 3.6. The outcome c) the banning of sugary drinks and foods high in fat, sugar and salt (HFSS) from checkouts has been maintained in all outlets The outcomes d) ensuring that healthy options are available at any point including for those staff working night shifts has been maintained via the healthy vending options and changes to vending at Churchill Hospital (CH) and Nuffield Orthopaedic Centre (NOC) The outcomes i) 70% of drinks lines stocked must be sugar free (less than 5 grams of sugar per 100ml). In addition to the usual definition of SSBs it also includes energy drinks, fruit juices (with added sugar content of over 5g) and milk based drinks (with sugar content of over 10grams per 100ml), has been achieved in all outlets The outcomes ii) 60% of confectionery and sweets do not exceed 250 kcal, has been achieved in all outlets The outcomes iii) At least 60% of pre-packed sandwiches and other savoury prepacked meals (wraps, salads, pasta salads) available contain 400kcal (1680 kj) or less per serving and do not exceed 5.0g saturated fat per 100g has been achieved in all outlets. 4. Conclusion 4.1. The retailers have engaged positively, the majority implementing step-wise changes throughout the year to comply with the three CQUIN indicators and have maintained the previously implemented four standards from last year. Achievement against these standards has been audited. Appendix 2 (sample audit sheet) 4.2. All retailers have signed a letter confirming compliance and continued commitment to these standards, which is to be signed off by the Trust, in preparation for the 31 March 2019 deadline. Appendix 3 (sample letter) This has been a significant amount of work for all the retailers but they have willingly supported the Trust in achieving the CQUIN. This commitment could be positively recognised by including them on both the Trust intranet and Trust website The Trust Board should note that the CQUIN goal for the period of April 2018 to March 2019 requires that all outcomes previously described continue but a further shift in percentages is required: % of drinks lines stocked must be sugar free (less than 5 grams of sugar per 100ml). In addition to the usual definition of SSBs it also includes energy drinks, fruit juices (with added sugar content of over 5g) and milk based drinks (with sugar content of over 10grams per 100ml) % of confectionery and sweets do not exceed 250 kcal At least 75% of pre-packed sandwiches and other savoury pre-packed meals (wraps, salads, pasta salads) available contain 400kcal (1680 kj) or less per serving and do not exceed 5.0g saturated fat per 100g. CQUIN 1b Healthy Food

6 5. Recommendation 5.1. The Trust Board is recommended to ratify the work undertaken and give sanction to the positive recognition of the retailers achievements. Paul Brennan, Director of Clinical Services Clare Dollery, Deputy Medical Director Author(s): Wendy Robinson, Soft FM Client Contract Manager Dr Emily Dobell, Public Health Registrar Date: 15 th February 2018 CQUIN 1b Healthy Food

7 Appendix 1 Summary of the implementation of step-changes amongst retailers on Trust premises to achieve the CQUIN indicators 1. Aramark retailer provides the restaurant; On Three at John Radcliffe site now branded as the Real Food Company. Aramark has worked nationally on these outcomes, designing concepts that offer customers a choice of healthier options. ocally, they have made significant changes to the displays at checkouts to include only healthier items such as fruit and nut mixes, fresh fruit and water. 2. Elior have taken over the restaurants at both the Churchill and Nuffield Orthopaedic Centre. They are new to the health sector but have addressed the healthier eating agenda, initially by banning all products HFSS. After receiving complaints from customers they have now re-introduced some CQUIN-compliant HFSS items to allow their customers a choice. 3. Carpenter s Catering (Benito) in the Postgraduate centre at the John Radcliffe has positively engaged and made changes to their layouts and product ranges, including a large range of fruit and salad pots. Price promotions are now only offered on healthier eating ranges. Food HFSS has been removed from the checkout. They have had the biggest challenge to reduce the calories in both their extensive salad pots, sandwich, wrap and ciabatta range as these contained double the recommended calories. They have recently taken the leap of faith to serve half sandwiches and ciabattas whilst also changing some of the fillings to low calorie mayonnaise. 4. Carillion manage the vending contract at the John Radcliffe site and have worked with the contractor to provide healthier vending options by The Rude Food Vending Company, not only in public areas but also staff areas such as theatres, the emergency department and maternity block. Sugar free and healthier products form a greater proportion of their stock and take a more prominent position in vending machines. Twenty four hour food availability is achieved with a frozen vending machine which stocks a range of ready meals compliant with calorie standards. 5. Horton in-house Restaurant and Vending Services have made step-changes to increase the proportion of low fat snacks and zero sugar drinks. HFSS have been removed from meal deals and products moved to ensure that healthier options are now more prominent. Fresh fruit, nuts and raisins are offered at checkout areas. Many HFSS items have been removed from vending machines and replaced with healthier options such as salads, rice cakes and fruit. 6. WHSmith Business Development Director has agreed a plan to ensure all WHSmith retail sites; the shop at John Radcliffe and the shop and café at Churchill will be CQUIN 2017/18 compliant. These changes are set to go live in February and to be complete by the end of March Marks & Spencer Simply Food and café at John Radcliffe have agreed a plan with their head office to ensure that they will be CQUIN 2017/18 compliant. These changes are set to go live in February and be complete by the end of March Pret a Manger at JR has been fully engaged in working towards these outcomes. They do not offer price promotions or advertise any food or drink HFSS. They have increased the range of fresh fruit, dried fruit and nuts as healthier options near to the checkout. Pret a Manger offer a balanced offer with healthier options CQUIN 1b Healthy Food

8 throughout the day. The fresh bakeries produce, whilst HFSS, remains behind glass cabinets by the checkout not for impulse purchase. 9. eague of Friends on the John Radcliffe site has made significant changes with fresh fruit provided at checkouts and an increased range of salad and fruit pots from Carpenter s catering offered as a healthy option. Any advertisements of foods HFSS have been removed and new stands arranged to remove products HFSS from the checkout areas. The West Wing eague of Friends have a new stand to display chocolate further away from the checkout area and have purchased a stand to ensure cakes are in a less prominent position, again, away from the checkout. 10. eague of Friends on the NOC site have positively engaged and rearranged the entire shop layout so that healthier options including fruit, fruit bars and nuts, are more visible. A large amount of fruit is now sold each week. They have bought in a healthier range of sandwiches and filled rolls which conform to the CQUIN requirements. 11. eague of Friends on the Churchill site have been limited in terms of space to display some products. Following the re-audit it was agreed that, with the provision of containers, rearrangement of products HFSS away from the checkout area could be guaranteed. CQUIN 1b Healthy Food

9 Appendix 2 Sample Audit Form Name: ocation: Date: Please insert your name Please insert your location Please insert today's date No. Category CQUIN 2017/18 standards Information required Answers Advice Exceptions / Clarifications 1 Drinks 70% of drinks lines stocked (displayed) Percentage of drink lines stocked which must have less than 5 grams of added have less than 5 grams of added sugar per sugar per 100ml. This includes energy 100ml drinks, fruit juices (with added sugar content of over 5g per 100ml) and milk based drinks (with sugar content of over 10grams per 100ml) % itres of beverages sold in October 2 Drinks itres of SSBs sold in October itres of beverages sold in November itres of SSBs sold in November itres of beverages sold in December itres of SSBs sold in December This is the number of displayed drink lines with less than 5mg added sugar (or 10mg if milk based) divided by the total number of drink lines displayed x 100 (e.g. if you have 6 drink lines with less than 5g sugar and 10 drink lines overall = 6/10 x 100 = 60% Milk based' is defined as a drink with at least 50% milk - these drinks count if they have more than 10g added sugar per 100ml 3 Confectionery & sweets 60% of confectionery and sweets do not exceed 250 kcal. Percentage of confectionery stocked which contain don't exceed 250kcal 4 Pre-packed At least 60% of pre-packed sandwiches Percentage of pre-packed savoury meals and other savoury pre-packed meals (wraps, salads, pasta salads) available contain 400kcal (1680 kj) or less per serving and do not exceed 5.0g saturated fat per 100g. sandwiches/wraps/pasta salads which don't exceed 400kcal or 5g saturated fat % % This is the number of displayed confectionery lines which have less than 250kcal divided by the total number of confectionery lines displayed x 100 This is the number of displayed prepackaged sandwich/wrap/salad items which have less than 400kcal and less than 5g saturated fat divided by the total number of packaged sandwich/wrap/salad items displayed This means that 60% of packets, bars, slabs, bags, lollipops, boxes, tins, festive items or units should contain no more than 250kcal. See confectionery definitions below. See '% stocked' definition below Only required if you pre-package these items. Does not currently apply to items 'made-to-order'. If stock constantly changes, please calculate at a time when stock is at its fullest Are there price promotions on items high in fat, saturates, salt or sugar? Are there advertisements for items high in fat, saturates, salt or sugar? Are items high in fat, saturates, salt or sugar placed at the checkout or queuing aisles? Yes / No Yes / No Yes / No See promotion, advert and checkout definitions below. CQUIN 1b Healthy Food Page 9 of 11

10 CQUIN 1b Healthy Food Page 10 of 11

11 Oxford University Hospitals Appendix 2 Sample etter TB2018 [Retailer name & address] Mark Neal Director of Estates & Facilities Oxford University Hospitals NHS Trust The John Radcliffe Hospital Headley Way, Headington Oxford OX3 9DU 19th February 2018 CQUIN 2017/18 Indicator 1b: Healthy food for NHS staff, visitors and patients We acknowledge that the provision of nutritious food and the creation of a healthy food environment forms a key part of Oxford University Hospitals NHS Foundation Trust s (OUHFT) aim to be a health promoting organisation. [Retailer name XXX], has been engaged with the Trust Healthier Eating Working Group to share knowledge, ideas and best practice to take action on the food and drink sold on NHS premises. Since April 2016, we have taken important steps to ensure healthier food and drink are available to staff, patients and visitors at the Trust, We remain committed to the changes made in the 2016/17 CQUIN Indicator 1b: Introducing healthy food for staff, visitors and patients, which were; the banning of price promotions on sugary drinks and foods high in fat, sugar and salt (HFSS) the banning of advertisement on NHS premises of sugary drinks and foods high in fat, sugar and salt (HFSS); the banning of sugary drinks and foods high in fat, sugar and salt (HFSS) from checkouts; and ensuring that healthy options are available at any point including for those staff working night shifts We offer assurance that [Retailer name XXX], are now compliant with the 2017/18 CQUIN Indicator 1b: Introducing healthy food for staff, visitors and patients, and commit to further incremental changes towards 2018/19 CQUIN. Evidence of the changes made during 2017/18 can be found in the attached evidence files. These changes include; 70% of drinks lines stocked have less than 5grams of added sugar per 100ml. In addition to the usual definition of SSB s it also includes energy drinks, fruit juices ( with added sugar content of over 5g) and milk based drinks (with sugar content of over 10grams per 100ml); 60%of confectionary and sweets do not exceed 250 kcal; and At least 60% of pre-packed sandwiches and other savoury pre-packed meals (wraps, salads, pasta salads) available contain 400 kcal (1680kJ) or less per serving and do not exceed 5g of saturated fat per 100g; Signatures: (Director of Estates & Facilities) [Retailer Nominated Representative] CQUIN 1b Healthy Food Page 11 of 11

Trust Board (public) Tuesday 28 February 2017 at 14:15 Meeting Room 1, Block 7, Fieldhead, Wakefield, WF1 3SP AGENDA

Trust Board (public) Tuesday 28 February 2017 at 14:15 Meeting Room 1, Block 7, Fieldhead, Wakefield, WF1 3SP AGENDA 1. Welcome, introduction and apologies (verbal item) 2. Declaration of interests (verbal